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05-016 (3) City of Northampton os s Massachusetts 4S�� DEPARTMENT OF BUILDING INSPECTIONS ,x 7 , 212 Main Street • Municipal Building Northampton, MA 01060 rs �ll�ti. INSPECTOR Louis Hasbrouck Chuck Miller Building Commissioner Assistant Commissioner HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his/her construction supervisor. The state defines "Homeowner" as, " Person(s) who owns a parcel on which he/she resides or intends to be, a one or two family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two- year period shall not be considered a home owner." The building department for the City of Northampton wants any person(s)who seek to use the home owner exemption, to act as their own construction supervisor, to be aware that by doing so you become responsible for compliance with state building codes and regulations. The inspection process requires that the building department be called to inspect work at various stages, which include foundation/footings (before backfill) sonotube holes (before pour) a rough building inspection (before work is concealed) insulation inspection (if required) and a final building inspection The building department requires these inspections before the work is concealed, failure to secure these inspections can result in failure to obtain a certificate of occupancy until the work can be inspected. If the homeowner hires other trades to perform work (electrical, plumbing & gas) the homeowner will be responsible to make sure that the trades hired secure their proper permits in conjunction to the building permit issued, and that they get their required inspections. Failure of the individual trades to secure the permits and inspections as required can DELAY the project until such time as the proper permits and inspections are made 11 I C-0iCAW' 17 S^ e1 1 understand the above. (Home owner/resident's signature requesting exemption) I will call to schedule all required building inspections necessary for the building permit issued to me. Date �/ %( /l i' Address of work location I 2 3 J4 c1 u ()p,,i L,eeef-f P11 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): �v� 14)e-t� Address: 123 /q uei o L-,,o,-7 C4� City/State/Zip: �e s 144d CYo S-3 Phone#: 4-13 -- S 8`t` Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. 0 I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g• F-1 Demolition working or me in an capacity. employees and have workers' g y p �'• 9. ❑ Building addition [No workers' comp. insurance comp. insurance.T required.] 5. E] We are:a corporation and its 10.❑ Electrical repairs or additions 3.[11-1 am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(4), and we have no employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. tHo meowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins. Lie. #: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certi er the pain and penalties of perjury that the information provided above is true and correct. Sign ature: _ Date: � / Z //� Phone#• 1 3" S``6`'`— 381f c3 Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: ty, PK)M'ONTAL WOOD BATTEN HOR;TONTAL'WC,K`M>BATT£N YPtiLfN WA U 80ARD`II':ti } ........ , WOOD MNDO YHEAn=R, m. (LeVVOOD514EATWNG VAPOR tIETAPDfR AND Aik { , 3 6A3NZIE'R ',SEiJ3.-PACtf C£tlViOS£itta"'daATi©N � < i T �4 I VSTSDAL'NOGD SOING, r t ' i x yEFi€'AL SNCXID BA'fTEPdt, YLiTERP€£C'DF HC1'>BE;YRAA ;..._ 314"PLY'AlOOD COR4,VENT SO"G VENT ,; z r HOUSEWIRAF'OVER.APS RASHINt3 ......, f �W Tt - RiG€DFOAXIINSULATICI9 METAL SLOPED FLA.SHdNC i} VLNTANVVfW.NGAi+ ' . cF •-'-t" _- _ d- "'^ YY043D ENY{,,Ay7fH; R 2 &4 WOOD EXTE`'LVON JAMB : ........ .RILED INSJ.ATK)N � t a 'A0DOD EXTENSION JAMS "ANDOW FLANGE TAPED TO HOLSES4FAP.�..«. 2X BLOCKING FOR FLANGED-WINDOW)MOUNTING €1 { I i 3 t ' E a i s ! 3 iX BLOCKING FOR 'VANDOW I'RAME TA?ItV rO FLANGE WINDOW MOUN"r#NG `., ({--+: _._�....._..._ BLOCKING ' MNDOW FLANGE TAPED TO HOUIEVL'RAP VJAT'CP,PRL`Oi MC.c.lSEbV"P --.-. t ._.... .W._., \ SILL AT 2 DEGREE SLANT 4 µ-. RIGID FOAM INSUI ArON WOOD CASING...... VERTICAL WOOD SIONG, < ,! ...... BfL�LOMCVdYfiNUG L'TAPED 6AUMGE:K D T O, .... RORtXONTAL WOOD BATTEN „, -' 1 i k Y` GOR4,VENT SdD&'G VENT S PLYWOOL) r� TYP.WINDOW HEAD AND SILL DETAIL A5,20 SCALE$”=1'-T Ben Weil 14'1,P 123 Audubon Rd. unk Roor-0 Leeds, MA 01053 �. Condition Prior to Renovation 14; 1 10' 7' 3 Bath 107 ft2 9'. 4" 15' lift 4 F�pom t Entry Room _-1168 ft2-' 205 ttf 9 4'° 15' 3' Main House co 1049 ft 2 34' �'� t��rev mac•+ �2rrGv A�'it��, .�C.c ;��,� T.5 - _ a e _ a d r smy, Vim,s. _.,� - _.. .. tlf1�,3 I".l'-, 'in if ta'rtc �� �•_ -mow ten""' /1 'f Mini-split heat new windows 3 pane, pump indoor low-e,U=.2 cassette Existing door replaced 14' 1 , with new 5' 1„ fiberglass existing window 2 pane, low-e,U=.32 foam core door. Guest Room Existing walls 2x6 t2 16"OC fiberglass with 169 f poly vapor barrier. '~ Vapor barrier removed, walls re-insulated as req'd. Existing plywood 4' 1" sheathing taped and existing window removed sealed as primary air barrier.Outboard of Deck/rat r, plywood sheathing,8"I- joists installed vertically t 013 " ­4 ' with cellulose densepack. s_. New Awning window 2" 2`' existing window 2 pane, installed above both Bath 0) / low-e,U=.32 tempered 7 fV glass -------- ---------------------------------- C16§6t „ 11 ' 2� 2?t 5 New Living Room P 6" 275 ft2 6d Room c''74 ft2 ' 6' 18' 7r' cur � E r "w 4. PLYIAO "�. 1z, t E Cl 3 F f i ^- f `a vy �. ,.y t ll oc , r r � 3 C- e Oat au f]1 { 3 " w Benjamin S. Weil June 10, 2014 123 Audubon Road. Leeds, MA 01053 413-584-3848 bweil @umass.edu 18. Insulate all outboard insulation trusses with dense packed cellulose. 19. Interior renovation of mudroom and new living room a. Electrical b. Interior insulation c. Drywall d. Flooring Process for roof on main house: 1. Strip roof 2. Install Proclima Mento 1000 air and water barrier membrane 3. Connect air barrier membrane to existing wall air barrier at existing taped foam board sheathing. 4. Install 12" wood I-joist rafters and insulate using the same process as described above for the additions (steps 6,7, and 8 above). S. Install vent space 6. Install OSB roof decking and underlayment 7. Install new asphalt shingles. Benjamin S. Weil June 10, 2014 123 Audubon Road. Leeds, MA 01053 413-584-3848 b.rveil@umass.edu Building Permit Narrative This is a request to add additional work to an existing permit that is still active: Permit# BP-2014-0788 Project# JS-2014-001344 In the process of building up the insulation and structure on the topside of the existing roof decking on the existing addition that was being renovated under the current permit, it became clear that it would be necessary and advantageous to re- roof and renovate the portion of the building to which the addition is attached. This is an opportunity to add insulation and re-roof the entire roof system of the house, and to increase the insulation and air tightness of the walls of the adjacent section of the house (noted as "Room 12" and "Entry Room" on the plan of the house prior to renovations). Renovation process for additions: 1. Strip roof. 2. Remove existing eaves and overhangs 3. Install water and air impermeable membrane (Proclima Mento 1000) with all seams taped. 4. Install 12" Wood I-Joist rafters on top of existing roof deck to create new eaves. 5. Build out new rake edges on gable ends. 6. Install air-sealed insulation dams at ends of rafter bays. These dams also serve as blocking to increase the lateral rigidity of the I-joist rafters. 7. Install vapor open, air and water barrier to contain cellulose and prevent windwashing 8. Install battens running along the rafters to create a vent space. 9. Install roof decking and underlayment 10. Install fascia, soffits and venting 11.Wrap air barrier down from roof(Mento 1000 WRB) and connect to wall air barrier 12. Remove siding, tape plywood seams. 13. Frame new window and door openings 14. Close up existing window and door openings in "Entry Room" and "Room 12" 15. Connect air barrier to existing floor system air barrier and blower door test. 16. Build out Larsen Truss on walls (8" on East,West,and North walls, 12" on South wall) 17. Install new windows and door SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable Rc Name of License Holder: License Number Address Expiration Date Signature Telephone 9. Registered Home Improvement Contractor: Not Applicable ❑ Company Name Registration Number I Address Expiration Date Telephone SECTION 10-WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152,§25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes....... ❑ No...... ❑ 11. - Home Owner Exemption The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(1) or two(2)families and to allow such homeowner to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor.CMR 780, Sixth Edition Section 1083.5.1. Definition of Homeowner: Person (s) who own a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two family dwelling,attached or detached structures accessory to such use and/or farm structures.A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official,on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. As acting Construction Supervisor your presence on the job site will be required from time to time,during and upon completion of the work for which this permit is issued. Also be advised that with reference to Chapter 152(Workers' Compensation) and Chapter 153 (Liability of Employers to Employees for injuries not resulting in Death)of the Massachusetts General Laws Annotated,you may be liable for person(s) you hire to perform work for you under this permit. The undersigned"homeowner"certifies and assumes responsibility for compliance with the State Building Code,City of Northampton Ordinances,State and Local Zoning Laws and State of Massachusetts General Laws Annotated. Homeowner Signature" SECTION 5-DESCRIPTION OF PROPOSED WORK check all applicable) New House ❑ Addition ❑ Replacement Windows Iteration(s) ❑V Roofing 0 Or Doors ❑✓ Accessory Bldg. ❑ Demolition ❑ New Signs [p] Decks Siding UZI Other[[::l Brief Wo kDWEMMUMper insulation of existing additions. Insulate and re-root entire roof. Alteration of existing bedroom x Yes No Adding new bedroom Yes x No Attached Narrative Renovating unfinished basement Yes x No Plans Attached Roll Sheet 6a. If New house and or addition to existing housing, complete the following: a. Use of building : One Family Two Family Other b. Number of rooms in each family unit: Number of Bathrooms c. Is there a garage attached? d. Proposed Square footage of new construction. Dimensions e. Number of stories? f. Method of heating? Fireplaces or Woodstoves_ Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction i. Is construction within 100 ft. of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No j. Depth of basement or cellar floor below finished grade k. Will building conform to the Building and Zoning regulations? Yes No . I. Septic Tank City Sewer Private well City water Supply SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, , as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date I,_ 'h ►G vh in Wig.; as Owner/Authorized Agent hereby Mclare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed un �and n (ties of perjury. 1 l fA �pams t I Print Name 6'1 12 Signature wner/Agent Date Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size 25,926 square feet 25,926 sq ft 195.1 ft 195.1 ft Frontage Setbacks Front 53 t Side L: 35 R. 120 L. 35 R: 120 367 367 Rear Building Height 24 ft 24ft Bldg.Square Footage 2144 % 2144 Open Space Footage 23,782 sq f % 3,782 s ft (Lot area minus bldg&paved q parking) #of Parking Spaces 4 4 Fill: (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO O DON'T KNOW O YES O IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DON'T KNOW O YES O IF YES: enter Book Page and/or Document # B. Does the site contain a brook, body of water or wetlands? NO O DON'T KNOW O YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained O , Date Issued: C. Do any signs exist on the property? YES O NO O IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES O NO 0 IF YES, describe size, type and location: E. Will the construction activity disturb (clearing, grading, excavation, or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES O NO O IF YES,then a Northampton Storm Water Management Permit from the DPW is required. Department use only �ity of Northampton Status of Permit: r , 00ilding Department Curb Cui/Driyeway Permit JUN 12 2014 i 1212 Main Street Sewer/Septic Availability Room 100 WaterANell Availability Electric, Plumbing&Gas Inspe ampton, MA 01060 Two Sets of Structural Plans Northampton, 4 E 0 87-1240 Fax 413-587-1272 Plot/Site Plans Other Specify APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: This section to be completed by off ice 123 Audubon Road Map Lot Unit Leeds, MA 01053 Zone Overlay District Elm St.District" CB District_ SECTION 2- PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Benjamin S.Weil 123 Audubon Rd.,Leeds,MA 01053 Na rint) Current Mailing Address: 413-584-3848 Telephone Signature 2.2 Authorized Agent: Name(Print) Current Mailing Address: Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building 40,000 (a) Building Permit Fee 2. Electrical 2,000 (b) Estimated Total Cost of Construction from 6 3. Plumbing 1000 Building Permit Fee 4. Mechanical (HVAC) 2,000 5. Fire Protection 6. Total = (1 +2+3+4+5) 45,00U Check Number Aq This Section For Official Use Only Date Building Permit Number: Issued: Signature: Building Commissioner/Inspector of Buildings Date File#BP-2014-0788 APPLICANT/CONTACT PERSON WEIL BENJAMIN SOLOMON&LISA MICHELLE RASCO ADDRESS/PHONE 123 AUDUBON RD LEEDS (413)584-3848 Q PROPERTY LOCATION 123 AUDUBON RD MAP 05 PARCEL 016 001 ZONE RR(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out d Jab Fee Paid Typeof Constr ion: RENOVATE& INSULATE ADDITION ADD CLOSET REMOVE 2 WINDOWS&ADD 2 WINDOW 6/12/14-INSULATE EXISTING ADDITIONS&MAIN HOUSE&NEW ROOF New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 3 sets of Plans/Plot Plan THE FO OWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO ATION PRESENTED: Approved Additional permits required(see below) PLANNING BOARD PERMIT REQUIRED UNDER:§ Intermediate Project: Site Plan AND/OR Special Permit With Site Plan Major Project: Site Plan AND/OR Special Permit With Site Plan ZONING BOARD PERMIT REQUIRED UNDER: § Finding Special Permit Variance* Received&Recorded at Registry of Deeds Proof Enclosed Other Permits Required: Curb Cut from DPW Water Availability Sewer Availability Septic Approval Board of Health Well Water Potability Board of Health Permit from Conservation Commission Permit from CB Architecture Committee Permit from Elm Street Commission Permit DPW Storm Water Management D oliti ela Si re of uil mg Officia Date Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning requirements and obtain all required permits from Board of Health,Conservation Commission,Department of public works and other applicable permit granting authorities. * Variances are granted only to those applicants who meet the strict standards of MGL 40A. Contact Office of Planning&Development for more information. 123 AUDUBON RD BP-2014-0788 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 05 -016 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: renovation BUILDING PERMIT Permit# BP-2014-0788 Project# JS-2014-001344 Est. Cost: $16000.00 Fee: $366.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Homeowner as Contractor Lot Size(sq. ft.): 25918.20 Owner: WEIL BENJAMIN SOLOMON&LISA MICHELLE RASCO Zoning: RR(100)/ Applicant: WEIL BENJAMIN SOLOMON & LISA MICHELLE RASCO AT. 123 AUDUBON RD Applicant Address: Phone: Insurance: 123 AUDUBON RD (413) 584-3848 O LEEDSMA01053 ISSUED ON:111312014 0:00:00 TO PERFORM THE FOLLOWING WORK:RENOVATE & INSULATE ADDITION,ADD CLOSET,REMOVE 2 WINDOWS &ADD 2 WINDOWS, 6/12/14 - INSULATE EXISTING ADDITIONS & MAIN HOUSE & NEW ROOF POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Underground: Service: Meter: Footings: Rough: Rough: House# Foundation: Driveway Final: Final: Final: Rough Frame: Gas: Fire Department Fireplace/Chimney: Rough: Oil: Insulation: Final: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy Signature: FeeType: Date Paid: Amount: Building 1/13/2014 0:00:00 $366.00 212 Main Street, Phone(413)587-1240, Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner 123 AUDUBON RD BP-2014-0788 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 05-016 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: renovation BUILDING PERMIT Permit# BP-2014-0788 Project# JS-2014-001344 Est. Cost: $16000.00 Fee: $96.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Homeowner as Contractor Lot Size(sq. ft.): 25918.20 Owner: WEIL BENJAMIN SOLOMON&LISA MICHELLE RASCO Zoning: RR(100)/ Applicant: WEIL BENJAMIN SOLOMON & LISA MICHELLE RASCO AT. 123 AUDUBONN RD Applicant Address: Phone: Insurance: 123 AUDUBON RD (413) 584-3848 O LEEDSMA01053 ISSUED ON.111312014 0:00:00 TO PERFORM THE FOLLOWING WORK.-RENOVATE & INSULATE ADDITIOKADD CLOSET,REMOVE 2 WINDOWS & ADD 2 WINDOWS POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Underground: Service: Meter: Footings: Rough: Rough: House# Foundation: �rJ Driveway Final: Final: Final: j Rough Frame: LJ ll`-t'� < Gas: Fire Department Fireplace/Chimney: Rough: Oil: .rsu!at;on Final: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy Siinatu..re: Date Paid: Amount: FeeType• ,L Building 1/13/2014 0:00:00 $96.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner